| NPI | 1164988028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN11009380) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9265580) |
| 207R00000X Internal Medicine (Licence: FL APRN1109380) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL APRN1109380) | |
| Enumeration Date | 2019-02-15 |
| Last Update Date | 2022-08-19 |